Spine Journal最新文献

{"title":"Radiographic phenotype-driven clustering in lumbar decompression: comparative study of outcome and reoperation risk.","authors":"Tomoyuki Asada, Sereen Halayqeh, Adrian Lui, Andrea Pezzi, Eric R Zhao, Adin M Ehrlich, Olivia C Tuma, Kasra Araghi, Tarek Harhash, Rujvee Patel, Kyle Morse, James E Dowdell, Sheeraz A Qureshi, Sravisht Iyer","doi":"10.1016/j.spinee.2025.04.015","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.04.015","url":null,"abstract":"<p><strong>Background context: </strong>Lumbar spinal canal stenosis (LSCS) presents with various radiographic findings, often including concurrent degenerative changes. Prior studies have investigated the effects of individual radiographic findings and parameters separately using conventional methods such as logistic regression. However, applying these independent effects to real-world patients remains challenging due to an unknown interaction effect among multiple degenerative radiographic findings.</p><p><strong>Purpose: </strong>To identify distinct patient phenotypes based on preoperative radiographic findings using unsupervised clustering and to evaluate their associations with postoperative patient-reported outcomes and reoperation rates.</p><p><strong>Study design: </strong>Retrospective cohort study PATIENT SAMPLE: Patients undergoing single-level lumbar decompression OUTCOME MEASURES: Oswestry Disability Index (ODI), Short Form-12 physical component scale (SF-12 PCS), reoperation rates METHODS: Unsupervised clustering was performed using preoperative radiographic data from standing X-ray imaging and magnetic resonance imaging (MRI). Variable selection was optimized through preliminary correlation analysis, causal assessment using a directed acyclic graph, and expert review. A multivariable mixed-effects model was used to assess the impact of cluster membership on postoperative outcomes. Reoperation rates were compared using Kaplan-Meier survival analysis and Cox proportional hazards models.</p><p><strong>Results: </strong>Unsupervised clustering identified four distinct clusters base on 10 radiographic variables: cluster 1 as \"Young and Less Degenerative Spine\" (cluster Y), cluster 2 as \"Combined Coronal and Sagittal Spondylosis\" (cluster CS), cluster 3 as \"Coronal Spondylosis Characterized by Laterolisthesis\" (cluster C), and cluster 4 as \"Sagittal Spondylosis Characterized by Degenerative Spondylolisthesis\" (cluster S). Multivariable regression analysis, adjusting for comorbidity, sex, and body mass index have revealed cluster C demonstrated slower improvement in ODI (β = 5.4, SE = 2.7, p=.043) and SF-12 PCS (β=-2.9, SE=1.4, p=.045) compared to cluster Y. Regarding reoperation, cluster CS showed the highest hazard ratio (24.3%, HR=4.18, 95% CI: 1.48-13.07, p=.007) compared to cluster S with the lowest reoperation rate (6.8%).</p><p><strong>Conclusion: </strong>Unsupervised clustering based on preoperative radiographic findings identified four distinct degenerative phenotypes in LSCS. Patients with coronal spondylosis was associated with slower improvements in disability and function compared to those with minimal degeneration. Additionally, patients with combined sagittal and coronal degeneration exhibited the highest reoperation rates. These findings highlight the clinical relevance of coronal and sagittal degeneration in surgical decision-making.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to letter to the Editor regarding “Impact of normalized total psoas area on postoperative mobility and perioperative adverse events in adult spinal deformity surgery”","authors":"Michael Mazzucco BS,&nbsp;Takashi Hirase MD, MPH,&nbsp;Chukwuebuka C. Achebe BS,&nbsp;Myles Allen MBChB,&nbsp;Robert N. Uzzo MBA,&nbsp;Gregory S. Kazarian MD,&nbsp;Hiroyuki Nakarai MD,&nbsp;Han Jo Kim MD,&nbsp;Francis Lovecchio MD","doi":"10.1016/j.spinee.2025.01.009","DOIUrl":"10.1016/j.spinee.2025.01.009","url":null,"abstract":"","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 5","pages":"Pages 1075-1076"},"PeriodicalIF":4.9,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143829854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to letter to the Editor regarding “Real world clinical outcomes when discontinuing denosumab or bisphosphonates in patients with surgically managed osteoporotic vertebral compression fractures: a population-based cohort study”","authors":"Chuan-Ching Huang MD, PhD ,&nbsp;Chih-Chien Hung MD ,&nbsp;Ho-Min Chen MS ,&nbsp;Jou-Wei Lin MD, PhD ,&nbsp;Shau-Huai Fu MD, PhD ,&nbsp;Chen-Yu Wang PhD","doi":"10.1016/j.spinee.2025.01.007","DOIUrl":"10.1016/j.spinee.2025.01.007","url":null,"abstract":"","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 5","pages":"Pages 1078-1079"},"PeriodicalIF":4.9,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143828604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor regarding “Impact of normalized total psoas area on postoperative mobility and perioperative adverse events in adult spinal deformity surgery” by Hirase et al","authors":"Langtao Ma ,&nbsp;Guiqian Zhang ,&nbsp;Sheng Lu","doi":"10.1016/j.spinee.2024.12.037","DOIUrl":"10.1016/j.spinee.2024.12.037","url":null,"abstract":"","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 5","pages":"Pages 1073-1074"},"PeriodicalIF":4.9,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143829853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor regarding “Types of high-riding vertebral artery: a classification system for preoperative planning of C2 instrumentation based on 908 potential screw insertion sites” by Klepinowski et al.","authors":"Yuwang Du MD,&nbsp;Hua Jiang MD, PhD","doi":"10.1016/j.spinee.2024.12.038","DOIUrl":"10.1016/j.spinee.2024.12.038","url":null,"abstract":"","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 5","pages":"Pages 1069-1070"},"PeriodicalIF":4.9,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143830013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to the letter to the Editor regarding “Types of high-riding vertebral artery: a classification system for preoperative planning of C2 instrumentation based on 908 potential screw insertion sites”","authors":"Tomasz Klepinowski MD, PhD,&nbsp;Leszek Sagan MD, PhD","doi":"10.1016/j.spinee.2025.01.006","DOIUrl":"10.1016/j.spinee.2025.01.006","url":null,"abstract":"","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 5","pages":"Pages 1071-1072"},"PeriodicalIF":4.9,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143829852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor regarding “Real world clinical outcomes when discontinuing denosumab or bisphosphonates in patients with surgically managed osteoporotic vertebral compression fractures: a population-based cohort study” by Huang et al","authors":"Yu Chang MD ,&nbsp;Da-Wei Huang MD ,&nbsp;Jung-Shun Lee MD, MSc","doi":"10.1016/j.spinee.2025.01.008","DOIUrl":"10.1016/j.spinee.2025.01.008","url":null,"abstract":"","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 5","pages":"Page 1077"},"PeriodicalIF":4.9,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143828603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of fusion status in patients with minimum 1-year survival post-oncologic spinal fusion.","authors":"Seth Wilson, Jacob Ward, Anas Bardeesi, Santino Cua, Vicente de Paulo Martins Coelho, Mark Damante, Daniel Kreatsoulas, J Bradley Elder, Joshua Palmer, David Xu, Vikram Chakravarthy","doi":"10.1016/j.spinee.2025.04.002","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.04.002","url":null,"abstract":"<p><strong>Background context: </strong>Oncologic patients have significant medical comorbidities which may impact arthrodesis after spine surgery. Furthermore, there is a paucity of published data describing fusion rates, and arthrodesis quality.</p><p><strong>Purpose: </strong>In this study, we present institutional data for patients with minimum 1-year survival who underwent spinal fusion secondary to treatment of metastatic spine disease.</p><p><strong>Study design/setting: </strong>Retrospective cohort study done at a single tertiary medical center.</p><p><strong>Patient sample: </strong>Patients were selected from a single institution between 2012 and 2022. Included patients had spinal fusion as part of oncologic treatment, minimum of 1 year follow up, and postoperative Computed Tomography (CT) scan at minimum 1 year.</p><p><strong>Outcome measures: </strong>Patient outcomes included fusion status and Hounsfield units (HU) on CT scan at 1 year.</p><p><strong>Methods: </strong>Retrospective chart review was performed collecting demographic and treatment information including postoperative oncologic and radiation treatment as well as HU along the cranial and caudal pedicles bilaterally on the 1-year CT scan. Indications for surgery included symptomatic metastatic disease. All surgeries were performed by 1 of 3 surgeons at a single tertiary medical center. Statistical analysis was performed using the Student T-Test and Chi-Squared Test.</p><p><strong>Results: </strong>There were 74 patients presenting with metastatic spine disease who met inclusion criteria. Demographics included an average age of 61.9 years at time of surgery, median construct length of 6 levels, and median survival was 43.2 months. Our cohort demonstrated complete and partial fusion rates of 11.1% and 59.5%, respectively. There was a significant difference in average HU for patients demonstrating fusion at 1 year, 444.2 compared to those demonstrating a lack of fusion, 285.8 (p<.0001). Patients who received postoperative radiation had higher postoperative HU than those who did not receive radiotherapy (411.1 vs. 304.9, p=.042). There was no significant difference in fusion status based on postoperative chemotherapy status, p=.127. Additionally, there was no difference in HU based on SBRT versus conventional radiotherapy, p=.588.</p><p><strong>Conclusion: </strong>Partial fusion was seen in over half of the study cohort at 1-year follow-up; complete fusion was seen in 11% of patients. Fused patients and those who received postoperative chemotherapy had significantly higher HU on 1-year CT. Maximizing control of cancer burden as well as improving bone quality may help patients with metastatic spine disease demonstrate bony fusion. More research is indicated to evaluate causal implications of survival in patients with metastatic spine disease that have undergone spinal fusion.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clarifying the impact of spine-specific sarcopenia and generalized sarcopenia on clinical features in patients with lumbar degenerative diseases.","authors":"Tianshu Feng, Jinbo Zhao, Jinghang Li, Yaoyu Wang, Lianlei Wang, Xinyu Liu","doi":"10.1016/j.spinee.2025.04.013","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.04.013","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The pathogenesis of paraspinal degeneration and sarcopenia, which is characterized by the decrease in generalized muscle quality and quantity, may be different in patients with lumbar degenerative diseases (LDD). In addition, the impact of them on the clinical features of LDD and their interaction are still unclear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To investigate the impact of generalized and spine-specific sarcopenia on the clinical features of patients with LDD and further examine the mediating role of paraspinal muscles STUDY DESIGN: A retrospective analysis of a prospective, nonrandomized cohort dataset.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;A total of 285 patients with LDD aged over 50 years were enrolled.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Sarcopenia was defined when low appendicular muscle mass was present in combination with low muscle strength or low physical performance, and spine-specific sarcopenia was designated below the gender median value of the total rfCSA of the MF at the L3/4-L5/S1 levels. Demographic variables and clinical features including reported outcome measures, spine sagittal parameters, paraspinal muscle parameters and imaging grading system.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Difference analysis was used to compare the differences between groups in demographic variables and clinical features. Linear regression models were used to evaluate the association between spine-specific and generalized sarcopenia and clinical features. Additionally, mediation analysis was employed to explore the role of paraspinal muscles in the pathway through which generalized sarcopenia affects clinical features.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The generalized-sarcopenia patients exhibited significantly higher scores for VAS-back (p=.03), VAS-leg (p=.038), ODI (p&lt;.001), SVA (p=.011) and tPfirrmann (p&lt;.001), while significantly lower scores were observed for JOA (p=.001), TK (p&lt;.001), LL (p=.005), and tDHI (p=.002). In the subsequent analysis, 36 of subjects were in the SSGS (spine-specific and generalized sarcopenia) group, 123 were in the NSSNGS (non-spine-specific and nongeneralized sarcopenia) group, 19 were in the NSSGS group and 107 were in the SSNGS group. Compared to the NSSNGS group, the SSGS group exhibited significantly lower JOA scores (p&lt;.001), higher ODI scores (p=.003), reduced TK (p=.005), reduced LL (p=.005), increased SVA (p&lt;.001), and a significantly higher tPfirrmann grading (p=.002). In Multiple linear regression analysis, the NSSNGS group exhibited significantly higher JOA, TK, LL, and tDHI values, with increases of 4.15 (p&lt;.001), 8.87 (p&lt;.001), 14.14 (p&lt;.001), and 0.11 (p=.012) times than SSGS group, respectively, along with significantly lower ODI (B=-11.44, p=.006), SVA (B =-44.96, p&lt;.001), and tPfirrmann grading (B=-2.29, p=.001). The mediation analysis indicated that paraspinal muscles play an important role in the association between generalized sarcopenia and LL (effect size=-1.3","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of lumbar disc degeneration based on interpretable machine learning models: retrospective cohort study.","authors":"Tenghui Li, Weihui Qi, Xinning Mao, Gaoyong Jia, Wei Zhang, Xiaofeng Li, Hao Pan, Dong Wang","doi":"10.1016/j.spinee.2025.04.004","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.04.004","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;The paraspinal muscles play a critical role in maintaining lumbar spine stability, and different muscles may have varying impacts on lumbar disc degeneration (LDD). However, studies exploring these relationships remain relatively limited.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;This study aimed to investigate the relationship between various paravertebral muscles and LDD and to develop and validate a predictive model for LDD using machine learning (ML).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Retrospective cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;A retrospective analysis was performed on hospitalized patients who underwent computed tomography (CT) and magnetic resonance imaging (MRI) examinations for chronic low back pain from February 2018 to January 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;The primary outcome measures included model performance metrics such as receiver operating characteristic (ROC) curves, accuracy, sensitivity, specificity, F1 score, positive predictive value (PPV), negative predictive value (NPV), and calibration curves. Clinical decision-making benefits were assessed using decision curve analysis (DCA). Secondary outcome measures focused on model interpretability, evaluated through SHapley Additive exPlanations (SHAP), which identified key predictors and quantified their contributions to LDD prediction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study enrolled 518 patients as the internal cohort, who were randomly assigned to a training set (70%) and a test set (30%). The Synthetic Minority Oversampling Technique (SMOTE) was applied to mitigate class imbalance in the training set. Model parameters were optimized using grid search and 10-fold cross-validation to develop four machine learning models: Extreme Gradient Boosting (XGBoost), Random Forest (RF), Logistic Regression (LR), and Decision Tree (DT). External validation was performed using data from 343 patients from different tertiary medical centers. Paraspinal muscle parameters on lumbar spine CT and MRI images were measured using ImageJ, and LDD was evaluated based on the Pfirrmann grading system. Spearman correlation analysis and logistic regression were performed to assess factors associated with LDD. Model performance was evaluated using metrics such as ROC curves, accuracy, sensitivity, F1 score, PPV, NPV, calibration curves, and DCA. The SHAP method was employed to interpret the ML models.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;This study included a total of 861 patients for analysis. In the external validation cohort, the XGBoost model demonstrated the best performance, achieving an AUC of 0.880 (95% CI: 0.826-0.935). Its accuracy (0.819), specificity (0.841), and positive predictive value (PPV=0.958) outperformed other models. Notably, it also exhibited superior sensitivity (0.814) and F1-score (0.880). SHAP analysis further revealed that age, the psoas muscle index (PMI), and the functional cross-sectional area (fCSA) of the ","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144010125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}